A Midstream voided urine collection
As part of a routine physical examination, a urinalysis is performed on a midstream voided urine collection from an apparently healthy (asmptomatic) 8-year-old girl. The following results are obtained on a fresh specimen:
| Physical Appearance | |||
| Color | Yellow | ||
| Transparency | Hazy | ||
| Chemical Screening | |||
| pH | 6.0 | ||
| Specific Gravity | 1.010 | ||
| Protein | (strip) 30mg/dL (1+) | (SSA) 1+ | |
| Blood | Neg | ||
| Nitrate | Neg | ||
| Leukocyte esterase | Pos | ||
| Glucose | Neg | ||
| Ketones | Neg | ||
| Bilirubin | Neg | ||
| Urobilinogen | Norm |
| Microscopic examination of urinary sediment | |
| RBC’s | 0-3/hpf |
| WBC’s | 10-25/hpf |
| epithelial cells | few (squamous) |
| bacteria | moderate (2+) |
After reviewing the results of the urinalysis the attending physician requests a gram stain and urine culture
| Microbiology Results: | |
| Gram Stain | Gram-positive cocci |
| Urine Culture | >100,000 CFU/mL of Enterobacter species |
1. Of the above results, which urinalysis findings are abnormal?
2. This lab does not perform microscopic examination on all routine urinalysis tests. Explain why microscopic examination of the urined sediment performed in this case?
3. Can the urine collection already tested be gram stained and cultured? Why?
4. Explain the negative nitrate results and the presence of bacteria in the urine sediment.
5. Would these results be more likely to represent an upper or lower urinary tract infection? Why?
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